Clearance rate and BP-ANN model in paraquat poisoned patients treated with hemoperfusion

Application of Hemoperfusion in the Treatment of Acute Poisoning

Rescue of acute poisoning is a race against time, and it is particularly important to remove toxic substances in time. Traditional methods include gastric lavage, promoting elimination, chelating agents, and other treatments. Hemoperfusion is a common blood purification technique. In the clinical practice of acute poisoning, hemoperfusion can directly remove toxic substances through its unique adsorption effect, showing its excellent efficacy. This paper reviews the experience of hemoperfusion in the treatment of various drug overdoses, pesticides, biological toxins, and industrial poisons, even drug addiction. It is hoped to provide a reference for clinicians in acute poisoning rescue.

Application of back propagation neural network model optimized by particle swarm algorithm in predicting the risk of hypertension

The structure of a back propagation neural network was optimized by a particle swarm optimization (PSO) algorithm, and a back propagation neural network model based on a PSO algorithm was constructed. By comparison with a general back propagation neural network and logistic regression, the fitting performance and prediction performance of the PSO algorithm is discussed. Furthermore, based on the back propagation neural network optimized by the PSO algorithm, the risk factors related to hypertension were further explored through the mean influence value algorithm to construct a risk prediction model. In the evaluation of the fitting effect, the root mean square error and coefficient of determination of the back propagation neural network based on the PSO algorithm were 0.09 and 0.29, respectively. In the comparison of prediction performance, the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the back propagation neural network based on PSO algorithm were 85.38%, 43.90%, 96.66%, and 0.86, respectively. The results showed that the backpropagation neural network optimized by PSO had the best fitting effect and prediction performance. Meanwhile, the mean impact value algorithm could screen out the risk factors related to hypertension and build a disease prediction model, which can provide clues for exploring the pathogenesis of hypertension and preventing hypertension.

Prognostic value of liver and kidney function parameters and their correlation with the ratio of urine-to-plasma paraquat in patients with paraquat poisoning

Acute paraquat poisoning resulting from multiple organ failure usually has a high mortality rate. Liver and kidney, as the key oranges of paraquat detoxification and elimination, their injuries may suppress toxin excretion and enhance the toxicity of paraquat in other organs and worsen the prognosis. Therefore, we intended to explore the prognostic value of liver and kidney function parameters, and further evaluate their correlation with a more stable index urine-to-plasma paraquat (urine paraquat concentrations/plasma paraquat concentrations) instead of considering paraquat concentrations in plasma or urine alone. The study included 33 patients with acute paraquat poisoning admitted to four centres in China from January 2018 to December 2019. Seventeen patients (10 male/7 female) survived, whereas 16 patients (7 male/9 female, 48.48%) died from paraquat poisoning. Alanine aminotransferase (ALT) and the blood urea nitrogen (BUN) represent liver and kidney function parameters, respectively. The ratio of urine-to-plasma paraquat is negatively correlated with ALT (r = -0.94, P = 0 .02) and BUN (r = -0.82, P = 0.03). For receiver operating characteristic curve (ROC) analysis, ALT, BUN and urine-to-plasma paraquat have an AUC over 0.80. The study shows that the functional indexes of liver and kidney, as well as the ratio of urine-to-plasma paraquat, could be considered for evaluating the extent of organ injury and excretion rate of paraquat.

Metabolomics Analysis in Acute Paraquat Poisoning Patients Based on UPLC-Q-TOF-MS and Machine Learning Approach

Most paraquat (PQ) poisoned patients died from acute multiple organ failure (MOF) such as lung, kidney, and heart. However, the exact mechanism of intoxication is still unclear. In order to find out the initial toxic mechanism of PQ poisoning, a blood metabolomics study based on ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) and efficient machine learning approach was performed on 23 PQ poisoned patients and 29 healthy subjects. The initial PQ plasma concentrations of PQ poisoned patients were >1000 ng/mL, and the blood samples were collected at before first hemoperfusion (HP), after first HP, and after last HP. The results showed that PQ poisoned patients all differed from healthy subjects, whatever they were before or after first HP or after last HP. The efficient machine learning approaches selected key metabolites from three UPLC/Q-TOF-MS data sets which had the highest classification performance in terms of classification accuracy, Matthews Correlation Coefficients, sensitivity, and specificity, respectively. The mass identification revealed that the most important metabolite was adenosine, which sustained in low level, regardless of whether PQ poisoned patients received HP treatment. In conclusion, decreased adenosine was the most important metabolite in PQ poisoned patients. The metabolic disturbance caused by PQ poisoning cannot be improved by HP treatment even the PQ was cleared from the blood.

Effect of activated charcoal hemoperfusion on renal function in patients with paraquat poisoning

The present study retrospectively analyzed 19 patients diagnosed with paraquat (PQ) poisoning with the aim to investigate the effect of activated charcoal hemoperfusion on renal function and PQ elimination. The results indicated that 7 patients died and 12 survived. Non-oliguric renal failure occurred in all of the 7 patients who died. Among the 12 surviving patients, 10 had normal renal function and 2 developed non-oliguric renal failure. There was a linear correlation between plasma and urine paraquat concentration prior to and during activated charcoal hemoperfusion. The equation parameters together with the correlation coefficient on admission were as follows: Y=0.5820+1.7348X (R²=0.678; F=35.768; P<0.0001). The equation parameters together with the correlation coefficient were as follows during activated charcoal hemoperfusion: Y=0.6827+1.2649X (R²=0.626; F=50.308; P<0.0001). Therefore, it was concluded that in patients with normal renal function, the elimination kinetics of PQ by the kidneys were only associated with the plasma PQ concentration. Activated charcoal hemoperfusion had little effect on avoiding acute kidney injury in patients with severe PQ poisoning.

Effects of hemoperfusion and continuous renal replacement therapy on patient survival following paraquat poisoning

Mortality in patients with paraquat (PQ) poisoning is related to plasma PQ levels. Concentrations lower than 5,000 ng/mL are considered critical but curable. This study assessed the effects of hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the survival of PQ-poisoned patients with plasma PQ levels below 5,000ng/mL. We analyzed the records of 164 patients with PQ poisoning who were treated at the First Affiliated Hospital of Wenzhou Medical University in China between January 2011 and May 2015. We divided these patients into six sub-groups based on baseline plasma PQ levels and treatment, compared their clinical characteristics, and analyzed their survival rates. Patient sub-groups did not differ in terms of age, sex, time between poisoning and hospital admission, or time to first gavage. Biochemical indicators improved over time in all sub-groups following treatment, and the combined HP and CRRT treatment yielded better results than HP or CRRT alone. Fatality rates in the three treatment sub-groups did not differ among patients with baseline plasma PQ levels of 50–1,000 ng/mL, but in patients with 1,000–5,000 ng/mL levels, the mortality rate was 59.2% (HP treatment group), 48% (CRRT treatment group), and 37.9% (combined treatment group). Mortality rates were higher 10–30 days after hospitalization than in the first 10 days after admission. In the early stages of PQ poisoning, CRRT is effective in reducing patient fatality rates, particularly when combined with HP. Our data could be useful in increasing survival in acute PQ poisoning patients.

Association of blood glucose and lipid levels with complete blood count indices to establish a regression model

Hyperglycemia and hyperlipidemia, which are usually diagnosed by analysis of blood glucose (GLU) and lipid levels, are two of the most common diseases in modern society. The purpose of the current study was to investigate the potential association between blood GLU and lipid levels with complete blood count (CBC) indices in overweight and healthy individuals and establish a regression model. There were 456 healthy and 421 overweight participants in the study. Data were collected on triglyceride (TG), total cholesterol (CHO), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood GLU and CBC. The distribution characteristics and differences between healthy and overweight subjects were analyzed. Subsequently, the associations between TG, CHO, HDL, LDL and GLU with CBC were analyzed using correlation analysis and multiple linear regression (MLR). Significant differences were identified between the healthy and overweight individuals in TG, CHO, HDL, LDL, GLU and in the majority of the CBC indices. The correlation analysis indicated that there were strong correlations between TG, LDL, HDL, CHO and GLU with CBC indices in the healthy and overweight subjects. The MLR demonstrated that the regression models of TG, LDL, HDL and CHO, but no GLU, were statistically significant in the two groups (P<0.001). The HDL regression model exhibited the best regression parameters; the multiple correlation coefficients (R) were 0.351 and 0.308 in the healthy and overweight subjects, respectively. In the overweight and healthy subjects, there were strong correlations between TG, LDL, HDL and CHO with CBC indices, with HDL being the most relevant to the CBC indices. The CBC demonstrated statistical significance in the diagnosis of hyperlipidemia.

An Effective Machine Learning Approach for Prognosis of Paraquat Poisoning Patients Using Blood Routine Indexes

The early identification of toxic paraquat (PQ) poisoning in patients is critical to ensure timely and accurate prognosis. Although plasma PQ concentration has been reported as a clinical indicator of PQ poisoning, it is not commonly applied in practice due to the inconvenient necessary instruments and operation. In this study, we explored the use of blood routine indexes to identify the degree of PQ toxicity and/or diagnose PQ poisoning in patients via machine learning approach. Specifically, we developed a method based on support vector machine combined with the feature selection technique to accurately predict PQ poisoning risk status, then tested the method on 79 (42 male and 37 female; 41 living and 38 deceased) patients. The detection method was rigorously evaluated against a real-world data set to determine its accuracy, sensitivity and specificity. Feature selection was also applied to identify the factors correlated with risk status, and the results showed that there are significant differences in blood routine indexes between dead and living PQ-poisoned individuals (p-value < 0.01). Feature selection also showed that the most important correlated indexes are white blood cell and neutrophils. In conclusion, the toxicity or prognosis of PQ poisoning can be preliminarily ascertained by blood routine testing without PQ concentration data, representing an additional tool and innovative approach to assess the prognosis of PQ poisoning.

Continuous plasma perfusion of dual cartridges in series: rationale and early clinical experience

To improve the efficiency of plasma perfusion on eliminating plasma paraquat (PQ), we designed continuous plasma perfusion of dual cartridges in series (CPPDCS) on Diapact Braun CRRT machine. The goals of this study were to evaluate the effective of CPPDCS on paraquat removal in patients with acute paraquat intoxication. Our results show that the PQ clearance rate of dual cartridges was significantly higher than that of single cartridge at 1st, 2nd, 3^rd, and 4th plasma perfusion. Compared with single-cartridge plasma perfusion, CPPDCS significantly reduced the frequency of cartridge replacement, shorten the time of perfusion. These results indicate that CPPDCS is effective than plasma perfusion of single cartridge on PQ clearance rate and may provide an effective treatment for PQ poisoning.

Prognosis and survival analysis of paraquat poisoned patients based on improved HPLC-UV method

Paraquat (PQ) has caused deaths of numerous people around the world. In order to assess the lethal plasma concentration, the patients who acquired acute PQ intoxication were analyzed by plasma concentration monitoring. The plasma PQ concentrations were determined by high performance liquid chromatography (HPLC) which used 5-bromopyrimidine as internal standard and trichloroacetic acid-methanol (1:9) as protein precipitant. The liver, kidney and coagulation function were determined by automatic biochemical analyzer. According to plasma PQ concentration, 90 patients were divided into four groups: trace PQ group (<50ng/mL), low PQ group (<1000ng/mL), medium PQ group (1000-5000ng/mL) and high PQ group (>5000ng/mL). The clinical data from the four groups was statistically analyzed. The results showed the developed HPLC methods exhibited a high degree of accuracy and good linearity within 50-25000ng/mL (R=0.9998). The Spearman's correlation analysis showed PQ concentration had a strong relationship to total bilirubin, direct bilirubin, aspartic transaminase, urea nitrogen, prothrombin time, prothrombin activity, and international normalized ratio (P<0.01). The cured or survival PQ poisoned patients among the trace PQ group, the low PQ group, the medium PQ group, and the high PQ group were 19/19 (100%), 19/21 (90.47%), 11/25 (44.0%), and 0/25 (0%) respectively. The mean hospital days were (10.37±8.04), (18.76±12.06), (16.76±14.44), and (4.04±5.41) days respectively. The Cox regression analysis indicated that plasma PQ concentration was highly related to prognosis (P<0.05). In conclusion, no patient presenting with a PQ concentration over 5000ng/mL survived. The plasma PQ level is related to liver, kidney and coagulation function, which can be used as an important clinical index to judge the prognosis of PQ poisoned patients.

CHEMICAL COMPOUNDS

Paraquat (PubChem CID: 15938), 5-bromopyrimidine (PubChem CID: 78344), acetonitrile (PubChem CID: 6342), sodium dihydrogen phosphate (PubChem CID: 23672064), sodium heptanesulfonate (PubChem CID: 23672332), methylprednisolone (PubChem CID: 6741), cyclophosphamide (PubChem CID: 2907).

Application of back-propagation artificial neural network and curve estimation in pharmacokinetics of losartan in rabbit

In order to develop pharmacokinetic model, a well-known multilayer feed-forward algorithm back-propagation artificial neural networks (BP-ANN) was applied to the pharmacokinetics of losartan in rabbit. The plasma concentrations of losartan in twelve rabbits, which were divided into two groups and given losartan 2 mg/kg by intravenous (Iv) and intragastrical (Ig) administration, were determined by LC-MS. The BP-ANN model included one input layer, hidden layers, and one output layer was constructed and compared with curve estimation based on the time-concentration data of losartan. The results showed the BP-ANN model had high goodness of fit index and good coherence (R > 0.99) between forecasted concentration and measured concentration both in Iv and Ig administration. The residuals of each concentrations generated by BP-ANN model were all smaller than Curve estimation. The pharmacokinetic result showed there was no significant difference between measured and simulated pharmacokinetic parameters including AUC(0-t), AUC(0-∞), MRT(0-t), MRT(0-∞), T1/2 V and Cmax (P > 0.05). In conclusion, the BP-ANN model has remarkably accurate predictions ability, which better than Curve estimation, and can be used as a utility tool in pharmacokinetic experiment.

Pharmacokinetics in rats and tissue distribution in mouse of magnoflorine by ultra performance liquid chromatography-tandem mass spectrometry

Magnoflorine is one of the most widespread aporphine alkaloids. In this work, a sensitive and selective ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for the determination of magnoflorine in rat plasma and mouse tissue have been developed and validated. After addition of nuciferine as an internal standard (IS), protein precipitation by acetonitrile-methanol (9:1, v/v) was used for samples treatment. Chromatographic separation was achieved on a UPLC BEH C18 column (2.1 mm×100 mm, 1.7 μm) with 0.1% formic acid and acetonitrile as the mobile phase with gradient elution. An electrospray ionization source was applied and operated in positive ion mode; multiple reactions monitoring (MRM) mode was used for quantification using target fragment ions m/z 342.8→298.2 for magnoflorine and m/z 296.0→265.1 for IS. Calibration plots were linear throughout the range 2-2000 ng/mL for magnoflorine in rat plasma and tissue. Mean recoveries of magnoflorine in rat plasma were better than 83.0%. RSD of intra-day and inter-day precision were both less than 9%. The accuracy of the method was between 95.5% and 107.5%. The method was successfully applied to pharmacokinetics and tissue distribution study of magnoflorine. The absolute bioavailability of magnoflorine was reported as 22.6%. The magnoflorine underwent a rapid and wide distribution to tissues; the level of magnoflorine in liver is highest, then followed by heart, spleen and lung. Based on tissue distribution data, a back-propagation artificial neural network (BP-ANN) method was developed and it could be used to predict the concentrations of magnoflorine in tissues.

Tissue distribution model and pharmacokinetics of nuciferine based on UPLC-MS/MS and BP-ANN

Nuciferine has shown remarkable biological activities and been considered as a promising drug. In this study, a sensitive and selective ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for determination of nuciferine in tissue and plasma. An electrospray ionization source was applied and operated in positive ion mode; multiple reactions monitoring (MRM) mode was used for quantification using target fragment ions m/z 296.0→265.1 for nuciferine, and m/z 322.0→307.0 for berberrubine internal standard (IS). Based on the UPLC-MS/MS method, the tissue distribution profile of nuciferine in mice and plasma pharmacokinetics in rat were studied. The results showed nuciferine was absorbed through intestinal tract and distributed into tissues rapidly. The bioavailability of nuciferine was identified at 17.9%. It can across through blood brain barrier, the concentrations in liver and kidney are highest, then followed by spleen, lung heart and brain. Nuciferine is eliminated quickly in the tissues and plasma, the t1/2 within 5 hour. The concentrations in these tissues are correlated to each other, and can be predicted by a back-propagation artificial neural network model.